Labyrinthitis: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On May 23, 2023

Labyrinthitis is an inflammation of an area of the inner ear known as the auricular labyrinth, which has anatomical structures responsible for maintaining posture and balance

The labyrinth, which also gives the disease its name, consists of two central structures

the cochlea, where incoming sound waves are converted into nerve impulses then transmitted to the brain

the organ of balance, filled with fluid and equipped with tiny hair cells. These cells register every movement of the fluid, transmit information about the position of the head to the brain and ensure our balance.

Labyrinthitis has a dual effect

On the one hand, it affects hearing; on the other hand, it contributes to a loss of balance, which can lead to vertigo, the most common symptom of this disorder.

Inflammation of the labyrinth may originate from a bacterial or viral infection; the latter may result from otitis or an upper respiratory tract infection.

There may, however, be other triggering factors such as a head injury, meningitis, an allergic reaction or severe stress.

Labyrinthitis can present in an acute or chronic form, leading to deafness and loss of vestibular function.

Symptomatology of labyrinthitis

The symptoms that can commonly be associated with labyrinthitis are

vertigo, which may occur continuously or following sudden changes in position or head movements. The sense of vertigo may be objective, in the case of perception of false movement of the surroundings, or subjective due to the distortion of one’s orientation in space
tinnitus (ringing in the ear)
sensation of pressure and pain inside the ears (especially if there is an ongoing infection)
posture problems and balance disorders
nystagmus (a condition characterised by involuntary, rapid and repetitive movement of the eyes)
paleness
headaches
nausea and vomiting
hypoacusis, i.e. hearing impairment of varying degrees
sialorrhoea (i.e. runny saliva due to difficulty swallowing)
fever
anxiety
dizziness and general malaise

Generally, labyrinthitis manifests itself at an early stage with acute and violent symptoms.

The diagnosis can be made through an ENT examination.

A nuclear magnetic resonance or CT scan can be used to assess the state of the inner ear and exclude more serious diseases.

An audiometric test is also usually carried out to assess any damage to hearing perception.

The causes

As already briefly mentioned, labyrinthitis can have several causes.

Therefore, in relation to them, one will distinguish different types of inflammation of the labyrinth:

viral labyrinthitis, when caused by viruses such as influenza, parainfluenza and cytomegalovirus
bacterial labyrinthitis, when it results from otitis or an upper respiratory tract infection; the bacteria that cause it are usually pyogenes such as streptococci, staphylococci and escherichia coli
labyrinthitis due to fracture of the petrous rock; the fracture of the part of the temporal bone in which the cavities of the inner ear where the labyrinth is located are hollowed out, can generate inflammation of the labyrinth itself. Generally, this disorder is more common among adults between 30 and 60 years of age.

In children, on the other hand, the following forms are more common

infantile purulent labyrinthitis, which develops at the same time as meningitis.
serous labyrinthitis, which accompanies both acute and chronic otitis media.

Labyrinthitis can also occur in connection with allergies, head trauma, cholesteatoma or Ménière’s syndrome.

As seen, the causes of labyrinthitis can be many.

It is essential, however, to identify the right origin, since depending on this, the specialist can recommend the most suitable therapies.

If treated promptly and thoroughly, labyrinthitis usually resolves completely.

Intervening as early as possible is therefore important to ensure the patient’s well-being and avoid unnecessary complications.

After the patient’s anamnesis, the medical specialist proceeds with a physical test, which is useful to check whether the dizziness and loss of balance are due to a problem with the vestibular system and labyrinth.

The patient suffering from labyrinthitis will undergo a series of more or less complex tests; the choice of test is determined by the intensity of the symptoms and the difficulty of ascertaining the disease.

Among the most commonly used tests are:

auditory brainstem response test, which consists of applying special earphones to the patient in which certain sounds or words are played; it is useful for checking the subject’s response to stimuli;
electronystagmography, a diagnostic test used to analyse vestibular disorders; it appears to be useful in ascertaining any further inability to control balance. The technique makes use of electrodes that are placed around the eyes and on the patient’s forehead; in turn, these electrodes are connected to an apparatus, which amplifies and records voluntary eye movement, caused by different factors (light stimulation, sensory, positioning, etc.)
bacterial culture test, which is essential to identify the pathogen responsible for labyrinthitis, as this is often generated by bacteria
CT (computerised axial tomography), a radiological diagnostic test that provides detailed images of the patient’s skull
MRI (magnetic resonance imaging), a diagnostic test used to reproduce images of the brain, including the capillaries and structures of the head. From the result, it is possible to check for any brain lesions associated with the pathology.

Therapies

Remedies for labyrinthitis tend to act on two levels: the first aims to alleviate the inflammation of the labyrinth, while the second has the function of intervening on the main symptoms to reduce their perception.

In cases where the triggering agent corresponds to a virus, prompt intervention combined with antiviral therapy can prevent severe damage to the inner ear.

Labyrinthitis developed as a result of a bacterial infection is treated with antibiotic therapy, while classic symptoms such as nausea, vomiting, dizziness and pain can be kept under control by administering antiemetics, anticholinergics, NSAIDs or cortisone.

If the patient suffering from labyrinthitis is anxious or agitated due to the particular clinical picture, treatment with anxiolytics and mood modulators may be beneficial, although it will not act on the triggers of the inflammation.

The pharmacological therapeutic approach can also be complemented by vestibular therapy, through the use of exercises to improve balance and reduce the sensation of dizziness.

In addition to the treatments mentioned above, there are further measures that can alleviate labyrinthitis

avoid abrupt and sudden changes of position, so as not to worsen the feeling of vertigo
do not expose yourself to particularly bright lights, so if possible reduce the brightness of your electronic devices and wear sunglasses even when it is cold outside
refrain from excessive alcohol consumption and smoking
avoid heavy stress
rest during the night
for those most at risk, avoid critical activities and driving during seizures
remain still during attacks

In the event that the diagnosis is made late in the course of the inflammation, there is a real possibility that the damage – especially with regard to auditory perception – may become permanent and some symptoms start the process of becoming chronic.

In the most serious and complex cases, recourse to surgery may represent the only decisive therapeutic solution.

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